A Systematic Review and Meta-Analysis of 29 Studies Predicting Diagnostic Accuracy of CT, MRI, PET, and USG in Detecting Extracapsular Spread in Head and Neck Cancers

BACKGROUND

Extracapsular spread (ECS) is the extension of cancer cells beyond the lymph node capsule and is a significant prognostic factor in head and neck cancers. This meta-analysis compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers.

METHODOLOGY

The authors conducted a systematic review and meta-analysis of studies that compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers. They included studies that were published between 1990 and December 2023 and that used histopathology as the reference standard for ECS.

RESULTS

The pooled sensitivity and specificity of CT scan were 0.63 (95% CI = 0.53-0.73) and 0.85 (95% CI = 0.74-0.91), respectively. The pooled sensitivity and specificity of MRI were 0.83 (95% CI = 0.71-0.90) and 0.85 (95% CI = 0.73-0.92), respectively. The pooled sensitivity and specificity of PET were 0.80 (95% CI = 0.74-0.85) and 0.93 (95% CI = 0.92-0.94), respectively. The pooled sensitivity and specificity of USG were 0.80 (95% CI = 0.68-0.88) and 0.84 (95% CI = 0.74-0.91), respectively. MRI had significantly higher sensitivity than CT scan (p-0.05). The specificity of CT and MRI was not significantly different (p-0.99). PET scan had the highest specificity among all imaging modalities.

CONCLUSION

MRI is the most accurate imaging modality for detecting ECS in head and neck cancers. CT scan is a reasonable alternative, but PET scan may be considered when high specificity is required. USG may not add any further benefit in detecting ECS.

Ultrasound-guided procedures for postoperative pain management in pediatric patients undergoing abdominal surgeries: A systematic review

Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different ultrasound-guided procedures to determine which procedure is better suited for pediatric abdominal surgeries. The objective is to understand the efficacy of ultrasound-guided procedures for postoperative pain management in children undergoing abdominal surgeries and to identify which procedure takes less time and is better suited for a particular surgery. A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric abdominal surgeries conducted with ultrasound-guided procedures for administering analgesia. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. We reviewed 13 articles with 910 patients included. Age groups varied from 6 months to 21 years. The most common block used was the transversus abdominis block (47.76%), and the most common surgery performed was hernia and hydrocele (52.10%). Quadratus lumborum block was used in 26.92%, erector spinae block in 8.97%, modified transversus abdominus block and rectus sheath block in 9.62%, and ilioinguinal block in 6.73% of the patients. No complications were reported in any of the studies. Transversus abdominus block is less effective in two of the studies. Each procedure for pediatric postoperative analgesia has specific advantages and limitations, highlighting the complexity of tailoring interventions. Our review focuses on the advancements in ultrasound-guided analgesia for lower abdominal surgeries in pediatric patients while also emphasizing the need for future randomized controlled trials (RCTs) to compare efficacy, standardize practices, and improve patient outcomes.

Positron emission tomography and its role in the assessment of vulnerable plaques in comparison to other imaging modalities

The diagnosis and management of vulnerable plaques are topics of high interest in the cardiovascular field. Although imaging techniques like computed tomography angiography (MCTA) and ultrasonography (USG) can structurally evaluate atherosclerotic plaques, they are limited in examining internal cellular processes. Positron emission tomography (PET) molecular imaging, on the other hand, can highlight these cellular processes, including inflammation, angiogenesis, and lipid oxidation. Magnetic resonance imaging (MRI) is also a valuable non-invasive imaging technique that can provide detailed anatomical and functional information on the cardiovascular system. In this review, we compare the advantages and drawbacks of MCTA, USG and MRI imaging techniques with PET molecular imaging in evaluating vulnerable plaques. PET imaging allows physicians to measure different pathophysiological events within the plaque using intravenous radiotracers, of which 18F-fluorodeoxyglucose (18F-FDG) is the most validated one. By using 18F-FDG, physicians can understand the formation of the plaque, assess the accumulation of macrophages, and predict major cardiovascular events. However, some limitations exist in using 18F-FDG, including myocardial uptake and low sensitivity in imaging coronary arteries. We also mention other radiotracers that can help in evaluating vulnerable plaques, including 18F-NaF. Although PET imaging is still challenging, it has shown promise in evaluating vulnerable plaques and could be used to intervene in high-risk patients before major cardiovascular events occur.

Is there a synergistic relationship between diaphragm and pelvic floor muscles in pregnant women?

OBJECTIVE

The aim of this study is to examine whether there is a synergistic relationship between the diaphragm and pelvic floor muscles (PFM) in pregnant women.

MATERIAL AND METHODS

Our study was carried out as a cross-sectional study in primigravid pregnants in the second and third trimesters. Superficial electromyography (EMG), 2D/3D ultrasonography (USG), pulmonary function test (PFT), PERFECT, maximum expiratory pressure (MEP) and inspiratory pressure (MIP) measurements were used to evaluate pelvic floor and diaphragm muscle functions during pregnancy. Mann-Whitney U test was used to show the change in the second and third trimesters, and Spearman correlation was used to determine the relationship.

RESULTS

No correlation was found between the EMG data of the PFM and diaphragm, or between the USG data of the PFM and diaphragm in all participants, in the second and third trimesters. In the third trimester of the study, diaphragmatic thickness and levator hiatal area (LHA) decreased and both diaphragm and PFM % MVC EMG parameters increased. In the third trimester, FVC, MIP, MEP decreased, and nonsignificant increase in FEV1, FEV1/FVC and peak ekspiratuar flow(PEF) were detected. A significant correlation was found between pelvic floor levator hiatal area USG and FEV1/FVC in both trimesters (r: 0,577p: 0,004).

CONCLUSION

There may be a synergistic relationship between the diaphragm and PFM in pregnant women, the relationship may weaken as pregnancy progresses, and there may be no coactivation relationship between the two muscles. In order to prevent the occurrence of pelvic floor dysfunction during pregnancy and to increase the effect of rehabilitation programs, the relationship between the diaphragm and the PFM should be determined and more studies should be conducted.

Validity of combined hydration self-assessment measurements to estimate a low vs. high urine concentration in a small sample of (tactical) athletes

PURPOSE

Relationships between body weight, urine color (Uc), and thirst level (WUT) have been proposed as a simple and inexpensive self-assessment method to predict dehydration. This study aimed to determine if this method also allowed us to accurately identify a low vs. high urine concentration in (tactical) athletes.

METHODS

A total of n = 19 Army Reserve Officer Training Corps cadets and club sports athletes (22.7 ± 3.8 years old, of which 13 male) were included in the analysis, providing morning body weight, thirst sensation, and Uc for five consecutive days. Each item received a score 0 or 1, resulting in a WUT score ranging from 0 (likely hydrated) to 3 (very likely dehydrated). WUT model and individual item outcomes were then compared with a ≥ 1.020 urine specific gravity (USG) cut-off indicating a high urine concentration, using descriptive comparisons, generalized linear mixed models, and logistic regression (to calculate the area under the curve (AUC)).

RESULTS

WUT score was not significantly predictive of urine concentration, z = 1.59, p = 0.11. The AUC ranged from 0.54 to 0.77 for test days, suggesting a fair AUC on most days. Only Uc was significantly related to urine concentration, z = 2.49, p = 0.01. The accuracy of the WUT model for correctly classifying urine samples with a high concentration was 68% vs. 51% of samples with a low concentration, resulting in an average accuracy of 61%.

CONCLUSION

This study shows that WUT scores were not predictive of urine concentration, and the method did not substantially outperform the accuracy of Uc scoring alone.

Imaging findings of orofacial cysticercosis: report of 5 cases with review of literature

Cysticercosis, a fatal disease of parasitic aetiology seen in humans, is caused by ingestion of larvae of Taenia solium in form of raw or poorly cooked pork. Commonly seen in developing countries, it affects the brain, muscle, lungs, heart and liver and is rarely found in the maxillofacial region. Sometimes, the only evidence of cysticercosis could be the cystic swellings or nodules in the maxillofacial region. Such solitary clinical presentation can be diagnosed early with the aid of ultrasound (USG) and Magnetic resonance imaging (MRI). Here, we present 5 cases of intramuscular cysticercosis of Orofacial region which were initially diagnosed on ultrasonography and later confirmed by MRI and aspiration cytology. We have conducted a systematic review of PubMed Literature for Intramuscular cysticercosis of orofacial region and highlighted key imaging findings from 18 cases retrieved. Through this case series, we highlight the USG and MRI imaging features of intramuscular cysticercosis which are characteristic and diagnostic of the condition.

Reasons for Requesting Ultrasonography: A Retrospective Study

OBJECTIVES

The aim of this study is to evaluate (i) the reasons for requesting ultrasonography (USG) in a dentistry faculty and (ii) the scanning regions, the type of probe used, and the use of Doppler USG.

METHODS

USG request forms of patients who applied to our radiology clinic for USG were analyzed retrospectively. According to the clinical information of the patients in the request forms, the reasons for requesting USG were divided into four groups: soft tissue swelling, soft tissue calcification, lymph node, and other examinations. Data were statistically compared between sex (female and male) and age groups (≤40-years-old and ˃40-years-old).

RESULTS

The USG request forms of 50 patients were obtained. The mean patient age was 45.06±14.50 years. Twenty-six patients were female (52%), while twenty-four patients were male (48%). Soft tissue swelling, soft tissue calcification, lymph node, and other examinations were noted as the reasons for requesting USG in 42%, 26%, 18%, and 14% of the patients, respectively. The most scanned regions were the submandibular (56%), parotid (16%), and cheek (10%) regions. Extraoral probe was used more frequently than intraoral probe (78% vs. 22%). Doppler USG was used in most patients (98%). A statistically significant difference was found between age groups and calcification examination (p<0.05).

CONCLUSION

The reasons for requesting USG were mostly soft tissue swelling, soft tissue calcification, and lymph node examinations. The most commonly scanned region and used type of probe were the submandibular region and extraoral probe, respectively. Doppler USG was used in most patients.

Contrast Induced Sialadenitis with Low Volume Non-ionic Contrast in a Patient with Cerebral Venous Sinus Thrombosis

Background: Contrast Induced Sialadenitis or Iodide Mumps refers to non-suppurative inflammation of salivary glands following intravenous iodinated contrast administration. It is a rare adverse effect of iodinated contrast with only a few cases reported worldwide. It is hypothesized to be an idiosyncratic reaction due to toxic accumulation of iodine in salivary glands. Case Report: We report a case of a 40-year-old female patient who underwent CECT brain after intravenous injection of 40ml of non-ionic iodinated contrast and developed symmetric painless swelling in bilateral submandibular triangles within five hours of contrast administration. Ultrasound with color doppler and MR imaging was performed which confirmed the diagnosis of contrast induced sialadenitis. Sialadenitis was managed conservatively and resolved slowly over eight days. Conclusion: Though it is a rare self-limiting adverse event of iodinated contrast, it must be known to the radiologist as well as the clinician to avoid unnecessary work up and manage the patient better.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03575-x.

Prolotherapy at Multifidus Muscle versus Mechanical Needling and Sterile Water Injection in Lumbar Spinal Stenosis

Objective

This observational study aimed to compare ultrasound-guided (USG) prolotherapy with 5% dextrose in water (D5W) in the multifidus muscle to USG mechanical needling and sterile water injections for the treatment of lumbar spinal stenosis (LSS).

Patients and Methods

The data was extracted from the medical records of ageing patients with LSS who received USG D5W in the multifidus muscle or USG mechanical needling and sterile water injections for the treatment of LSS by the first author. Low back pain or axial pain and leg pain or radicular pain were assessed by the visual analogue scale, and gait ability with walking distance were obtained at six different time points.

Results

Among the 211 older people who were diagnosed with LSS, 104 got USG mechanical needling and sterile water injections over the course of four weeks, while the other 107 got D5W at the multifidus muscles in a single session. Chronic low back pain, radiating pain, and the ability to walk all got much better at 1 and 3 months after the intervention, compared to VAS measures taken at the start. Patients who underwent mechanical needling with injections of sterile water performed consistently and significantly better than those who received prolotherapy in the multifidus muscles on all measures at 1, 3, and 6 months.

Conclusion

After receiving USG mechanical needling and sterile water, LSS patients reported significant improvements in low back pain, radicular pain, and ability to walk for at least 6 months. Prolotherapy with D5W in the multifidus muscle has a moderate effect for only three months.

Correlation between refractive error, muscle thickness, and bioelectrical activity of selected masticatory muscles

OBJECTIVE

The aim of this study was to analyze the correlation between the refractive error, muscle thickness, and the bioelectrical activity of selected masticatory and neck muscles in subjects with myopia.

METHODS

For bioelectrical activity analysis within the masticatory muscles, an 8-channel BioEMG III electromyograph was used. An M-Turbo ultrasound machine was used to analyze the masticatory and neck muscle thickness.

RESULTS

Statistical analysis showed significant positive correlations between masseter muscle thickness at rest on the right side. Statistical analysis showed negative correlations between the digastric muscle and Activity Index within masticatory muscles at rest on the left side when the eyes were closed.

CONCLUSIONS

As refractive error increases in myopic subjects, the resting tension on the temporal muscles increases, an increase in masseter muscle thickness is noted, and a decrease in bioelectrical activity on the digastric muscle at rest.

Comparison of Diagnostic Accuracies of USG, MG and MRI Modalities Defined with BI-RADS Classification System

BACKGROUND

BI-RADS classification provides facilitating information in diagnosis for radiologists. It allows radiologists to interpret mammograms accurately Objective: We aimed to compare the diagnostic accuracy of the modalities with the BI-RADS classification system made with imaging findings accompanied by USG, MG and MRI, which are a total of 3 modalities.

METHODS

This study included 82 patients who underwent Tru-Cut biopsy under the guidance of USG, MG, and MRI. Mammography, sonography and MRI were performed in the prone position.

RESULTS

Of the patients, 46.3%, 14.6%, and 39.0% were assessed in 4A, 4B, and 5 MRI BI-RADS categories, respectively. Based on the variable surgical/pathological diagnosis, 50%, 28.0%, and 22.0% of the patients were categorized as malignant findings, benign findings, and infection-inflammation-mastitis, respectively. The determination of the endpoints for the parameter of long-axis diameter (mm) was found to be statistically significant according to ROC analysis as a gold standard performed based on specificity levels of benign and malignant findings (p<0.05). A significant correlation was detected between the gold standard and the categorical variable MRI BI-RADS (χ^2=46.380, p<0.01).

CONCLUSION

When specificity and sensitivity of all three modalities in surgical/pathological diagnosis were compared, it was concluded that MRI was superior to the other modalities, and a valuable method in prediction of lesion malignancy and determination of biopsy prediction and priority.

Ultrasonographic signs of acute ovarian torsion

Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Teenage patient was referred to the gynecology ward with pain located in the lower, right abdomen, after an initial misdiagnosis of a dermoid cyst. The patient was diagnosed with a torsion of the right ovarian peduncle. The patient was given diastolic drugs and was discharged in good general condition two days later after the symptoms had resolved. Final USG showed normally vasculated corpus luteum. Among the various treatment options, the wait-and-watch attitude turned out to be the best solution. It is particularly important in the case of young patients, who are planning pregnancy in the future.

Evaluation of non-invasive tests as diagnostic tools in assessment of bladder outlet obstruction severity in men with anterior urethral stricture

Introduction

The aim of this article was to evaluate non-invasive tests, which were typically used in preoperative diagnosis of male patients with anterior urethral strictures in the assessment of the urethral resistance caused by urethral occlusion.

Material and methods

A total of 63 adult males with confirmed urethral stricture and aged below 55 years old were enrolled in the study. Data obtained from non-invasive tests such as uroflowmetry (UF), ultrasound examination (USG), and questionnaires such as from The International Prostatic Symptom Score (IPSS), and The Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) were analyzed.

Results

Among all analyzed non-invasive tests, bladder wall thickness (BWT) showed the highest correlation with the degree of urethral occlusion described as percentage of preserved urethral lumen (r = -0.70; p <0.0001). UF variables presented medium degree of correlation, with maximum flow rate (Qmax) as the best parameter (p = 0.45; p = 0.0005). Results from both questionnaires did not show any correlation with the severity of the urethral stricture. Multiple linear regression analysis showed that only BWT was an independent predictor in detection degree of urethral occlusion.

Conclusions

UF and USG seem to be useful additional diagnostic tools in assessment severity of urethral occlusion in men suffering from anterior urethral stricture. Among them, USG had the highest correlation with degree of urethral occlusion.

Comparison of the time taken for subarachnoid block using ultrasound-guided method versus landmark technique for cesarean section - A randomized controlled study

Background and Aims:

Spinal anesthesia is the regional technique preferred for cesarean section and is usually administered using the traditional landmark technique. Ultrasonography of the spine appears to be helpful in locating the puncture site and increasing the success rate. The primary objective of this study was to assess the use of ultrasonogram in locating the lumbar interspinous space for spinal anesthesia in laboring parturients brought for elective cesarean section.

Material and Methods:

Sixty parturients scheduled to undergo elective cesarean section under spinal anesthesia were included in this prospective randomized controlled trial, after obtaining the institutional ethical clearance. In Group I, 30 patients received spinal anesthesia by landmark technique and in Group II, 30 patients underwent ultrasound-guided spinal anesthesia. The statistical analysis was done using SPSS software version 17 (SPSS Inc., Chicago, Illinois, USA) for Microsoft windows.

Results:

The time taken for spinal in Group I was longer than in Group II (62 ± 18s; 41 ± 11s; P = 0.0001). The number of attempts of needle insertion was significantly less in Group II (group I 1.86 ± 1.04: group II 1.06 ± 0.25). However, the total preparation time (28 8.30 ± 92 vs 804.73 ± 77; P = 0.0001) was more in the ultrasound-guided than in the landmark group. The patients had better satisfaction in group II.

Conclusion:

Preprocedural ultrasound is a useful tool for successful lumbar puncture in parturients as it minimizes the number of attempts of needle insertion and provides better patient satisfaction.

Disseminated histoplasmosis leading to end stage liver failure in immunocompetent patient: case report and review of literature

Histoplasmosis is the fungal infection caused by Histoplasma capsulatum fungus. It is commonly found in a few endemic areas in the United States, where there is a large number of birds or bats and can spread through their droppings. Disseminated histoplasmosis is a severe manifestation of the fungal infection which is commonly seen in individuals with underlying immunosuppression. Our case is an unusual case of disseminated histoplasmosis in a 60-year-old, immunocompetent male patient with a history of significant alcohol abuse, which led to end stage liver failure. While the patient showed some signs of improvement initially upon beginning the treatment, he ultimately continued to deteriorate despite treatment due to an overwhelming histoplasmosis infection. This case demonstrates the importance of keeping a high index of suspicion even amongst immunocompetent patients with no obvious exposure to risk factors. It also shows that timely diagnosis with a high index of suspicion is required with an integrated treatment approach.

Ultrasound-guided fine needle aspiration cytology of angiosarcoma of head and neck: a review of cytomorphologic features and discussion of diagnostic pitfall of aspiration cytology of vascular lesions

Angiosarcoma is a rare malignant tumor of vascular origin (<2% of sarcomas). It represents <1% of all head-neck malignancies. A cytological diagnosis on fine needle aspiration (FNA) is extremely difficult. Most tumors yield a predominantly hemorrhagic aspirate with only rare neoplastic cells, a diagnostic pitfall of aspiration cytology of vascular lesions. An 81-year-old male, 2 years status post resection of a nasal tip angiosarcoma and adjuvant radiation therapy, presented to another institution with an enlarging left neck mass of 2 months duration. Outside FNA diagnosis of cyst was made. Patient was referred to our institution for a pathologist-performed ultrasound-guided FNA. Ultrasound examination revealed a hypoechoic cystic left neck mass. Direct smears showed blood with occassional single malignant spindled to epithelioid cells, with some cells showing "spider-leg" like cytoplasmic processes/projections and "tadpole/fiber" like morphology. Immunohistochemistry performed on cell block sections revealed the tumor cells to be positive for D2-40, CD31 and CD34, supported a diagnosis of regional recurrent angiosarcoma. Left neck dissection showed recurrent high-grade angiosarcoma infiltrating periparotid soft tissues and metastatic angiosarcoma involving multiple lymph nodes. A diagnosis of angiosarcoma on FNA samples can be challenging, as the aspirate may contain only rare tumor cells hidden in a background of abundant blood. Such cases require careful screening to avoid an incorrect diagnosis of inadequate or cyst contents. This short review highlights key cytomorphologic features of angiosarcoma, includes novel cytologic features of angiosarcoma which has not been described previously and also discusses challenges and diagnostic pitfalls of FNA of vascular lesions.

Athletes' Self-Assessment of Urine Color Using Two Color Charts to Determine Urine Concentration

Our objective was to determine self-reported accuracy of an athletic population using two different urine color (Uc) charts (8-color vs. 7-color Uc chart). After approval by the Institutional Review Board, members of an athletic population (n = 189, 20 (19–22) year old student- or tactical athletes and coaches, with n = 99 males and n = 90 females) scored their Uc using two charts. To determine the diagnostic value of Uc, results were compared with urine concentration (osmolality and urine specific gravity, USG). Uc was scored slightly darker with the 8-color vs. 7-color Uc chart (2.2 ± 1.2 vs. 2.0 ± 1.2, respectively, p < 0.001), with a moderate correlation between charts (r = 0.76, 95% CI: 0.69–0.81). Bland-Altman analysis showed a weak reporting bias (r = 0.15, p = 0.04). The area under the curve for correct urine sample classification ranged between 0.74 and 0.86. Higher accuracy for both methods was found when Uc scores were compared to USG over osmolality, indicated by 4.8–14.8% range in difference between methods. The optimal Uc cut-off value to assess a low vs. a high urine concentration for both Uc charts varied in this study between 1 and ≤2 while accuracy for charts was similar up to 77% when compared to USG.

Reliability of Three Urine Specific Gravity Meters Measuring Brix and Urine Solutions at Different Temperatures

CONTEXT

The measurement of urine specific gravity should be performed at room temperature (20 °C) but sample temperature is not always taken in consideration.

OBJECTIVE

Evaluate the effect of sample temperature on the measurement accuracy of a digital (DIG) and optical (MAN) refractometer and a hydrometer (HYD).

DESIGN

Quantitative comparison between measurement outcomes for a reference solution (sucrose, degrees Brix) and fresh collected urine samples.

SAMPLES

Experiment 1 used a 24 Brix (°Bx) samples and experiment 2 used 33 fresh urine samples.

MAIN OUTCOME MEASURE

Urine specific gravity (USG).

RESULTS

Experiment 1 showed DIG and MAN did not differ from reference, but HYD reported lower or inconsistent values compared to Bx, while highly correlating with Bx solutions (r: > 0.89). The overall diagnostic ability of elevated USG (≥ 1.020; ≥ 1.025; ≥ 1.030) was high for all tools (AUC > 0.92). Misclassification of samples increased from 0 to 2 at 1.020 to 1 to 3 samples at cutoff 1.025 and 1.030 USG. Bland-Altman analysis showed DIG 5 °C underreports slightly without reporting bias (r: -0.344, P = 0.13); all other plots for DIG, MAN, and HYD showed considerably larger underreporting at higher concentrations (r ranging from -0.21 to -0.97 with P > .02) at all temperatures. The outcomes of experiment 2 using DIG 20°C as standard, showed only negligible differences between DIG and MAN at all temperatures, but larger differences using HYD.

CONCLUSIONS

All tools showed reporting bias when compared to °Bx solutions which can impact classification of low and high urine concentration at higher USG cutoff values, especially at a sample temperature of 37 °C.

The Effect of a Tailored Intervention on Female Soccer Players' Hydration Status

Numerous studies have reported that athletes' pre-training/-game hydration status is of concern. Up to now, only two cohort studies have examined the effect of an intervention aimed at improving pretraining/-game hydration status; however, without including a control group. Therefore, the aim of this quasi-experimental study was to examine whether and to what extent an individually tailored intervention focused on the benefits of being optimally hydrated before training or game would alter the hydration status of female soccer players. Two teams of young adult female soccer players were allocated to an intervention (n = 22; 19.8 ± 3.0 years) or a control group (n = 15; 22.8 ± 4.0 years). Players in the intervention group received an individually tailored intervention, based on Urine Specific Gravity (USG) measurements, which took place in between two training weeks. Before each training and match play, a urine sample was collected to determine players' hydration status. Mixed modelling was applied to assess within and between differences in hydration status over time. The pre-training/-game hydration status of the intervention group improved significantly, with players' mean USG-value decreasing from 1.013 ± 0.001 g/mL to 1.008 ± 0.002 g/mL (p = 0.005). In contrast, the mean USG-value in the control group increased significantly from 1.012 ± 0.002 g/mL to 1.016 ± 0.002 g/mL (p = 0.023), indicating a deterioration of their pre-training/-game hydration status. The individually tailored intervention did show a positive effect even though female soccer players in the present study were already reasonably well hydrated before the start of the intervention.

Potential Acute Renal Injury in Sheep with Bluetongue Serotype 4

Bluetongue is a vector-borne disease with epidemic potential. Recently, outbreaks of Bluetongue were reported across Greece, caused by the Bluetongue virus (BTV) serotype 4. Regarding its pathogenesis, BTV infection involves various target organs with limited data referring to the kidneys. The objective of this study was to identify the possible impact of BTV infection on kidneys using common renal biomarkers. Urine and blood samples collected from 30 sheep with clinical signs of bluetongue (BTV sheep) and 30 clinically healthy sheep (normal sheep) from the same farms were finally selected and included in the study from an initial population of 47 sheep per group, based on the absence of active urine sediment. Complete urinalysis was performed and urine protein to creatinine ratio (UPC) and urine gamma-glutamyl transferase to creatinine (UGGTC) ratio were determined. Blood urea nitrogen (BUN), creatinine, total proteins, albumin (ALB), and inorganic phosphate (P) were determined in serum samples. UPC and UGGTC were significantly higher (p < 0.05) in BTV sheep compared to normal, whereas urine specific gravity (USG) was significantly lower (p < 0.05). Cylindruria was also detected in BTV sheep, and absence of azotemia in BTV and normal sheep. All these findings are indicative of renal tubular injury and/or dysfunction and suggestive of an association between BTV infection and acute damage of renal tissue.

A lavatory urine color (LUC) chart method can identify hypohydration in a physically active population

PURPOSE

To provide a new and efficient at-the-toilet-bowl method of self-assessing urine concentration via urine color (Uc) to identify hypohydration.

METHODS

A large athletic population (n = 189) delivered a urine sample, then chose a color panel that was displayed on the back wall of the lavatory stall. Selection was based on duration of urine voiding time, so that for a short-duration, the lighter panel was selected; for a mid-duration, the mid color panel; and for a longer-void-duration, the darker panel was selected. Then, subjects noted if their urine was lighter than, similar to, or darker than the selected color panel. Trained investigators also rated subjects' urine samples. To assess validity of Uc classification, the outcome was compared with a urine concentration (urine specific gravity, USG, and urine osmolality) threshold indicating hypohydration.

RESULTS

Urine color was scored similarly by subjects and investigators (P = 0.99). Based on receiver operating curves (ROC), the method scored fair, i.e., the area under the curve ranging 0.73-0.82, with an accuracy of participants and investigators correctly classifying 72% and 75% urine samples compared to a USG threshold of 1.020, respectively, and 62% and 70% compared to a urine osmolality threshold of 836 mmol·kg^-1, respectively.

CONCLUSION

This new lavatory urine color (LUC) method of scoring Uc levels to assess potential hypohydration gives results similar to those of traditional urine color charts, but it has the advantage of an immediate assessment of hydration status based on scoring urine color directly from the toilet bowl.

Role of Platelet Rich Plasma in Chronic Plantar Fasciitis: A Prospective Study

INTRODUCTION

Autologous platelet rich plasma (PRP) local injection has been recently proposed as a treatment of plantar fasciitis. The autologous PRP does not have much side effects compared to steroid injections. So far PRP injections have shown promising results in various studies. This study assessed the efficacy of a single local injection of PRP in chronic unilateral plantar fasciitis through a prospective case series.

METHODOLOGY

A hospital-based prospective case series of 30 unilateral plantar fasciitis patients with symptom duration of 6 months or more were included in the study. All patients included in the study were assessed clinically and by visual analogue score for heel pain, AHS component of AOFAS and FADI scores before injection and at 6 and 12 week follow-up. USG measurement of plantar fascia thickness was done at pre-injection and at 12 weeks follow-up. All patients were observed for 12 weeks.

RESULTS

The mean age was 39 years (range 20-55 years). The pre-injection VAS score for heel pain was 6.5 ± 1.1 which improved to 2.7 ± 0.5 and 1.8 ± 0.8 at 6 and 12 week respectively and difference was significant (p < 0.001). The baseline FADI and AHS component of AOFAS scores were 53.1 ± 9.0 and 72.2 ± 5.7 which improved to 65.5 ± 5.3 and 76.1 ± 4.5 at 6 weeks and, 77.9 ± 4.4 and 85.7 ± 4.6 at 12 weeks respectively which was significant (p < 0.001). The baseline mean plantar fascia thickness was 4.9 ± 0.3 mm which was significantly (p < 0.001) reduced to 3.9 ± 0.3 mm at 12 weeks post PRP injection. All pairwise comparisons by the post-hoc Wilcoxon signed rank test with p-value adjustment were also significant.

CONCLUSION

The short-term results of single dose PRP injections shows clinical and statistically significant improvements in VAS for heel pain, functional outcome scores and plantar fascia thickness measured by USG. This study concludes that local PRP injection is a viable management option for chronic plantar fasciitis.

Comparison of Ultrasonography with Conventional Radiography in Diagnosis of Zygomatic Complex Fractures

Introduction

The diagnosis of zygomatic complex fractures is important in planning the treatment since the complex gives form to the projection, width and height of the midface.

Aim

This study was carried out to assess the diagnostic sensitivity and utility of high-resolution ultrasonography in comparison with conventional radiography in the diagnosis of the zygomatic complex fractures.

Materials and Method

Twenty-five cases of clinically diagnosed zygomatic complex fractures were subjected to conventional radiographs and USG study.

Results

The accuracy in terms of specificity and sensitivity of USG was comparable to conventional radiographs in the detection of the fractures of the zygomatic complex.

Conclusion

This study points to the suitability of USG as an alternative to the use of plain radiographs in the diagnosis of zygomatic complex fractures. USG is safe, inexpensive and an accurate adjunct to conventional radiography in diagnosis of zygomatic complex fractures.

Clinical Applications of Imaging Modalities of the Carpal Joint in Dogs with Particular Reference to the Carpal Canal

The structure of the canine carpal joint is complex. This small joint consists of articulations that include the antebrachiocarpal, middle, carpometacarpal, and intercarpal joint surfaces. A large number of ligaments and tendons support and stabilise the carpus in dogs. Many injuries of this joint in dogs are not correctly recognised, diagnosed, or treated due to the limited use of diagnostic imaging methods. Radiography, the most common of them, has extensive application in diagnosing the causes of lameness in small animals. Other techniques, such as ultrasonography, computed tomography, and magnetic resonance imaging visualise other joint structures and surrounding soft tissues. However, these imaging modalities are rarely used to diagnose diseases and injuries of the canine carpus at present. The main reason for this is the small amount of research carried out and the lack of a properly described methodology for the use of imaging techniques. The wide use of all diagnostic imaging tools in the diagnosis of diseases and injuries of the wrist joint in humans shows that conducting studies on dogs could expand current knowledge. The use of these techniques in veterinary medicine could facilitate diagnosis and subsequent therapy of carpal disorders in dogs. MRI is the most frequently used imaging method in human medicine for visualisation of abnormalities of joints. This method could become a valuable part of the detection of inflammatory, traumatic, and degenerative diseases of the carpal joint in dogs.

Ultrasonographic evaluation of feto-placental tissues at different intrauterine locations in rabbit

The main purpose of examining multiparous species with real-time ultrasonography is to determine the gestational age and make various fetal measurements for early diagnosis of growth anomalies and sibling mismatches. This study investigated changes in fetometric measurements, obstetric Doppler indices and placental image analysis results based on gestational age and fetal location in fetuses located cranially and caudally between 16 and 24 days gestation in 22 healthy pregnant New Zealand rabbits. The first study group consisted of fetuses positioned at the cranial end (n = 22) while the second group consisted of fetuses positioned at the caudal end (n = 22) in each pregnancy. Fetal biparietal head diameter (BPD) and trunk diameter (TD) were measured, and mean grayness values (MGV) were determined from placental image analysis of each fetus. Using Doppler USG, the pulsatile (PI) and resistance (RI) indices of the uterine artery (UtA) and umbilical artery (UmA) were recorded. By the end of the study, BPD and TD values for cranial and caudal fetuses had significantly increased with gestational age (P < 0.001). The MGV values of caudal fetuses were significantly higher (except for the 16th day) (P < 0.05). The UtA PI value of the caudal fetuses was significantly higher (except for the 18th day) (P < 0.01). The UtA RI values of caudal fetuses were significantly higher than cranial ones on the 16 and 24th days (P < 0.05). The PI of the UmA increased until the 20th day before decreasing significantly in both study groups (P < 0.001). The UmA RI value decreased according to the gestational age in both groups (P < 0.001). It was significantly higher in the caudal fetuses on the 20th day (P < 0.05). The somatic rate of all fetuses peaked at the end of the second trimester, although caudal fetuses had higher fetometric values, and this location difference also affected placental echotexture. In both vessels of caudal fetuses, pulsatility and resistance values were higher. The 20th day of pregnancy was a threshold for the Doppler exam results. In conclusion, growth and metabolic status of fetuses located in different uterine locations in healthy pregnant New Zealand rabbits vary. Based on the these growth curves and hemodynamic data, more comprehensive studies of intrauterine life may be possible.

Urinalysis and determination of the urine protein-to-creatinine ratio reference interval in healthy cows

Background

There are no reference intervals for urinalysis in cattle.

Hypothesis/Objectives

Characterize the urine of healthy cows, establish urine protein‐to‐creatinine ratio (UPC) reference intervals, and test possible differences among dairy and beef cattle, age groups, or stage of lactation.

Animals

Seventy‐seven dairy and 74 beef 2.5 to 17 year‐old cows of different breeds housed mainly in free stall.

Methods

In this prospective study, urine specimens were collected by catheterization. Complete urinalysis was performed within 1 hour including specific gravity, dipstick evaluation, visual urine pH evaluation with 0.3 pH unit graded strips, and microscopic evaluation of the sediment. Urinary protein and creatinine concentrations and protein electrophoresis were determined on frozen aliquots.

Results

Overall reference intervals were 1.020 to 1.045 for USG, 7.0 to 8.7 for pH, and 0.04 to 0.25 for UPC; because of differences in creatinine concentration, UPC was lower in beef (0.04‐0.14) than in dairy (0.05‐0.25) cows and in the latter in dry than lactating cows. With dipstick evaluation, most analytes were absent except for blood, ketone, and protein in 24.7, 16.0, and 64.7% of cases, respectively. Microscopic evaluation revealed less than 3 red blood cells, leukocytes, and epithelial cells in 84, 99.3, and 100% cows, respectively. No band was observed at electrophoresis, except in 1 case at MW ~66 000.

Conclusions and Clinical Importance

Creatininuria is higher in beef than dairy cows and proteinuria is likely more efficiently characterized by protein concentration than by UPC.

Clinicopathological and Radiological Study of Thyroid Swelling

Thyroid swelling is the most common swelling among the endocrine disorder. It can affect any age group. USG neck will help to diagnose the solid and cystic lesions. The treatment is surgical excision. FNAC is a good diagnostic tool to minimize the incidence of thyroidectomy. FNAC is cost effective, reliable and OPD procedure. Final diagnosis can only be made by HPE postoperatively. The aim of this study is to find out the relative occurrence of various pathological conditions presenting as midline thyroid swellings and clinicopathological and radiological examination of the thyroid swellings. A one and half year prospective study which was carried out from October 2016 to April 2018 in ENT department of MMIMSR, Mullana, Ambala. Informed written consent was taken from all the patients. A complete clinical, radiological, cytological an HP Examination was done. Total 50 patients were included in the study. Complete clinical data of the patient was gathered from medical records. The maximum number of patients in present study was found in an age group of 31-40 years (34%). There was female predominance with female to male ratio of 7.3:1. Most of the patients belonged to rural background i.e. 42 (84%) patients. Most of the patients present with Left sided neck swelling i.e. 18 (36%) patients. Ultrasound revealed that non neoplastic lesions were present in 44 (88%) patients and 6 (12%) patients had neoplastic lesions. FNAC showed that non neoplastic lesions were present in 38 (76%) patients and 12 (24%) patients had neoplastic lesions. On HPE, non neoplastic and neoplastic lesions were present in 36 (72%) and 14 (28%) patients respectively. Colloid goiter was the most common among the non neoplastic lesions in 29 (58%) patients. Papillary carcinoma was the most common malignant disease in 4 (8%) patients. Thyroid swelling was most commonly seen during the 3rd and 4th decade of life, with a female preponderance. Most common benign thyroid swelling is Colloid goiter and papillary carcinoma was the most common malignant disease. Histopathology is considered as a gold standard.

A Multimodality Navigation System for Endoscopic Fetal Surgery: A Phantom Case Study for Congenital Diaphragmatic Hernia

This article presents a multi-modality tracking and navigation system achieved by merging optical tracking and ultrasound imaging into a novel navigation software to help in surgical pre-planning and real-time target setting and guidance. Fetal surgeries require extensive experience in coordination of hand-eye-ultrasound-surgical equipment, knowledge, and precise assessment of relative anatomy. While there are navigation systems available for similar constrained working spaces in arthroscopic and cardiovascular procedures, fetal minimally invasive surgery does not yet have a dedicated navigation platform capable of supporting robotic instruments that can be adapted to the set of unique procedures. This article discusses the testing of the novel multi-modality navigation system in a phantom environment developed for this purpose. The outcomes suggest that the subjects demonstrated an increase in average reaching accuracy by about 60% and an overall reduction in time taken by 33.6%. They also showed higher levels of confidence in reaching the targets, which was visualised from the pattern of trajectory of movements during the procedure. To evaluate the navigation system, a phantom surgical environment was found necessary. Therefore, the article also discusses the details of the development of a fetal phantom environment for congenital diaphragmatic hernia for surgical testing, evaluation, and training. A surgical procedure was conducted on the phantom using the proposed tracking navigation system and using only ultrasound.

Branchial cleft cysts: a pictorial review

Cystic masses of the neck may represent a wide variety of pathological conditions. Among these, branchial anomalies are the commonest paediatric congenital lesions of the head and neck. This article intends to review this condition under the same headings, as well as facilitate their diagnosis with the help of appropriate radiological findings of patients diagnosed with these anomalies. In order to make an accurate diagnosis, it is imperative to have an idea about the possible differentials, and the normal embryological development of the branchial arches, as well as their anomalies, in the form of sinuses, fistulae, and cysts, with their features and subtypes. The medical history of the patient and clinical manifestations helps in suspecting branchial cleft cysts; confirmatory imaging modalities include computed tomography, magnetic resonance imaging, ultrasonography, and fine-needle aspiration. The mainstay of management is usually by surgical excision. The location, clinical picture, and radiological correlation, along with a strong degree of suspicion for the condition, facilitates the diagnosis of this relatively common embryological anomaly.

Schistosomiasis and hydration status: Schistosoma haematobium, but not Schistosoma mansoni increases urine specific gravity among rural Tanzanian women

OBJECTIVES

Schistosome infections can damage organs important for water homeostasis, especially the kidneys. Urogenital schistosomiasis (caused by Schistosoma haematobium) increases protein and blood in urine and intestinal schistosomiasis (caused by S. mansoni) affects total body water. However, no data exist on how different schistosome species affect urine specific gravity (USG), a hydration biomarker. Therefore, we assessed the relationship between S. haematobium- and S. mansoni-infected and uninfected women and USG in rural Tanzania.

MATERIALS AND METHODS

Surveys were conducted and stool and urine samples were collected among 211 nonpregnant women aged 18-50. S. haematobium eggs were detected using the urine filtration method. S. mansoni eggs were detected using the Kato Katz method. USG was measured using a refractometer and analyzed as both a continuous and dichotomous variable. Regression (linear/logistic) models were estimated to test the relationship between infection and hydration status.

RESULTS

The prevalence of S. haematobium was 5.9% and S. mansoni was 5.4% with no coinfections. In regression models, S. haematobium-infected women had significantly higher USG (Beta = 0.007 g mL^-1 ; standard error = 0.002; p = 0.001) and odds (Odds ratio: 7.76, 95% CI: 1.21-49.5) of elevated USG (>1.020 g mL^-1 ) than uninfected women, whereas S. mansoni-infected women did not.

DISCUSSION

Schistosoma haematobium, but not S. mansoni, infection is associated with higher USG and risk of inadequate hydration. Future work should determine whether findings are attributable to parasite-induced debris in urine or urinary tract pathologies and signs of renal damage. Human and non-human primate studies using USG in schistosome-endemic areas should account for schistosomiasis.

Atypical spleen tuberculosis in a melanoma patient accidentally detected during a 18F-FDG PET/CT study: Case report

The present study, discussed a rare case of a 50-year-old woman who was treated for malignant melanoma and underwent ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) examination for evaluation of disease. ¹⁸F-FDG-PET/CT examination was performed from the top of the head down to the knee using a Gemini TF PET/CT scanner 60 min following intravenous injection of radiotracer with mean activity of 364±75 MBq. Previous performed laboratory test and clinical examination was irrelevant. By abdominal ultrasound no abnormalities in abdominal organs beside the liver cyst were found. The ¹⁸F-FDG PET/CT exam showed an increased glucose metabolism in the anterior pole of the spleen, which was considered as melanoma metastasis. Splenectomy was performed and histopathology examination tuberculous lesion in the spleen was revealed. Histopathology examination showed epithelioid granuloma and in correlation with the patient's history allowed to establish tuberculous-like lesions in the spleen. In the present study, authors used ¹⁸F-FDG PET/CT examination to detect the melanoma metastasis of a 50-year-old woman, and found that abnormal focal accumulation of radiotracer with limited cancer specificity in PET/CT examination in cancer patients should not be unambiguously taken as a metastatic lesion.

Role of endoscopic ultrasound in idiopathic pancreatitis

Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP (IRAP). Idiopathic acute pancreatitis (IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. Endoscopic ultrasound (EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed.

Temporalis cysticerci - A diagnostic dilemma and review of literature

Cysticercosis is a systemic parasitic infestation caused by ingesting the eggs of the pork tapeworm, Taenia solium. The central nervous system (CNS) is the most important primary site of infection and disease can present with solitary or multiple space-occupying lesion. Other organs like subcutaneous tissues, muscles, heart, liver, lungs, and peritoneum are more frequently affected but maxillofacial region involvement is rare. The diagnosis of cysticercose is evoked on US examination and CT scan, but confirmation is only possible by Fine needle aspiration cytology [FNAC] or histological examination in case of surgical removal of the oral lesion which can identify the Taenia solium larva. Solitary intramuscular cysticercosis in maxillofacial region, without involvement of CNS is a rare entity. We present a rare case of solitary temporalis muscle involvement without any systemic or neurologic infestation, which presented the diagnostic and therapeutic dilemma along with review of literature.

Role of routine abdominal ultrasonography in intensified tuberculosis case finding algorithms at HIV clinics in high TB burden settings

Background

High proportion of TB in people living with HIV (PLHIV) is undiagnosed. Due to this active TB case finding is recommended for HIV clinics in high TB burden countries. Presently sputum examination and chest radiography are frontline tests recommended for HIV infected TB presumptives. Abdominal TB which occurs frequently in PLHIV may be missed even by existing programmatic intensified case finding protocols. This study evaluated the routine use of ultrasonography (USG) for active case finding of abdominal TB in HIV clinics.

Methods

Retrospective analysis of eight years’ data from an HIV Clinic in a TB hospital in India. Patients underwent chest x-ray, sputum examination, USG abdomen and routine blood tests at entry to HIV care. Case forms were scrutinized for diagnosis of TB, USG findings and CD4 cell counts. Abdominal TB was classified as probable or possible TB. Probable TB was based on presence of two major USG (abdomen) findings suggestive of active TB, or one major USG finding with at least two minor USG findings or at least two symptoms, or any USG finding with microbiologically confirmed active TB at another site. Possible TB was based on the presence of one major USG finding, or the presence of two minor USG findings with at least two symptoms. Bacteriological confirmation was not obtained.

Results

Eight hundred and eighty-nine people PLHIV underwent a baseline USG abdomen. One hundred and thirteen of 340 cases already diagnosed with TB and 87 of the 91 newly diagnosed with TB at time of HIV clinic registration had abdominal TB. Non-abdominal symptoms like weight loss, fever and cough were seen in 53% and 22% cases had no symptoms at all. Enlarged abdominal lymph nodes with central caseation, ascitis, splenic microabsesses, bowel thickening and hepatosplenomegaly were the USG findings in these cases.

Conclusions

Abdominal TB is a frequent TB site in PLHIV presenting with non-abdominal symptoms. It can be easily detected on basis of features seen on a simple abdominal ultrasound. Abdominal USG should be essential part of intensified TB case finding algorithms for HIV infected people living in high TB burden settings.

Posterior capsule rupture with herniation of lens fragment following blunt ocular trauma

Posterior capsule rupture with herniated lens fragment in the vitreous cavity on magnetic resonance imaging has not been reported in India until now; however, it has been reported in other countries. Therefore, this study reports the case of a 15-year-old boy presenting with posttraumatic loss of vision in the right eye due to posterior capsular rupture and herniation of lens material into the vitreous cavity, which was detected by B-scan ultrasonography and magnetic resonance imaging as no ophthalmic examination was possible due to the posttraumatic cataract. The patient was treated by lens aspiration with anterior chamber vitrectomy and placement of posterior chamber intraocular lens, with the patient achieving 6/6 visual acuity postoperatively. This case is unusual due to the rarity of the findings, and it highlights the crucial role of imaging in achieving timely diagnosis and surgery to restore vision in the affected eye.

Fetal MR Imaging Analysis of Sirenomelia with Clinico Radiographic Correlation: A Case Report

Sirenomelia is a social curiosity, a medical and diagnostic challenge prenatally compounded by varied diagnostic difficulties. Prenatal diagnosis of sirenomelia was and continues to be a challenge although von klippel et al., described a case at 10 weeks of gestational age. However, they needed a second imaging at 12(th) week for confirmation. First trimester or early second trimester anatomic survey on ultrasound and MRI is accurate for the diagnosis thereby avoiding unnecessary complex pregnancy. We report a case of second trimester diagnosed sirenomelia, with detailed analysis of image findings on ultrasound and fetal MRI.

Zinner syndrome-a rare developmental anomaly of the mesonephric duct diagnosed on magnetic resonance imaging

Developmental anomalies of the urogenital tract are rare but often encountered. Zinner's syndrome is a rare congenital abnormality of mesonephric (Wolffian) duct consisting of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction due to developmental arrest in early embryogenesis affecting the caudal end of Mullerian duct and only approximately a 100 cases have been reported so far. Radiologic modalities such as intravenous pyelography, ultrasonography, vasovesiculography, contrast enhanced computed tomography, and magnetic resonance imaging are all helpful in diagnosis of this unusual entity. We present here an extremely rare developmental anomaly involving the Mullerian ducts, which would remain undiagnosed but for radiologic imaging. The patient presented with symptoms of lower urinary tract irritation.

Comparison of ultrasonography with conventional radiography in the diagnosis of zygomatic complex fractures

PURPOSE

Zygomatic complex fractures have changed in patterns of occurrence, severity, and, more importantly, in the mode of injury. Protection of the globe and maintaining the width of the face are the more important roles of the complex. Diagnosis and treatment planning of such fractures become imperative in the sequencing of repair if and where indicated, especially in the case of isolated zygomatic complex fractures. Exploring the versatility of ultrasonography (US), in diagnosing zygomatic complex fractures in comparison to conventional radiography in a double-blind study, the objective of this study was to evaluate the efficacy of US and to explore the possibility of making US examination a mainstay in the primary diagnosis of such fractures.

MATERIAL AND METHOD

The prospective, double-blind study design included 32 patients suspected of having sustained isolated zygomatic complex fractures. The patients underwent US examination and radiographic examination in the form of para-nasal sinus (PNS) and sub-mentovertex (SMV) views for comparison.

RESULTS

A sensitivity of 100% was seen in favor of US in the areas of the fronto-zygomatic suture (FZ), arch, infra-orbital, and buttress areas. Statistically significant differences (p < .01) was seen in areas of the arch and buttress region and in the infra-orbital area.

CONCLUSION

Although US showed 100% sensitivity in detection of fracture lines at three articulations of the four that make up the zygomatic complex, it lacked in quantifying the amount and degree of displacement of the fractured segments, which hampered accurate treatment planning.

A Rare Case of Pneumoureter: Emphysematous Pyelitis versus Emphysematous Pyelonephritis

Emphysematous pyelitis is a rare benign entity which is defined as isolated gas production in the pelvicalyceal system, ureters or in the urinary bladder as a consequence of acute bacterial renal infection. In this case report we present a case with no prior medical history of diabetes or urinary obstruction who presented with uncontrolled hyperglycaemia for the first time associated with emphysematous pyelonephritis. Further, the imaging differences between emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) has been discussed along with the approach and their management.

Ectopic Pregnancy in caesarean section scar: A case report

We report a rare case of ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography and confirmed by 3.0-T magnetic resonance imaging of pelvis. We present the clinical details and imaging findings, followed by discussion of the etiology, pathogenesis, and imaging of this condition.

Imaging Diagnosis of Herlyn-Werner-Wunderlich Syndrome- An Extremely Rare Urogenital Anomaly

Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract resulting from maldevelopment of both Mullerian and Wolffian ducts. It is characterized by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. It generally presents at puberty shortly following menarche with the symptom of acute pelvic pain. Management of these cases is surgical and consists mainly of vaginoplasty with excision of the vaginal septum in order to release the obstruction and prevent the long term complication of recurrent pyocolpos and infertility. We report here a case of Herlyn-Werner-Wunderlich syndrome in a 13-year-old adolescent girl, emphasizing the role of imaging in the accurate and prompt diagnosis of this rare developmental urogenital anomaly. Only a few hundred such cases have been reported in literature till date.

Ultrasonographic changes in dogs naturally infected with tick borne intracellular diseases

Tick-borne infectious diseases constitute an emerging problem in Veterinary Medicine. The study was undertaken to find out the ultrasonographic changes of liver and spleen in 101 positive cases of tick borne intracellular haemoparasitic diseases in dogs. Abdominal survey of ultrasonography revealed hypo echogenicity of liver, gall bladder distension, splenomegaly, hepato-splenomegaly and ascites in various tick born intracellular diseases viz. ehrlichiosis, babesiosis, anaplasmosis, hepatozoonosis and in mixed infection. Correlating these USG finding with other laboratory examination will be very much useful to spot the diseases condition and organ involvement in tick born intracellular diseases of dog.

Extrahepatic biliary atresia with choledochal cyst: Prenatal MRI predicted and post natally confirmed: A case report

Extrahepatic biliary atresia (EHBA) is an uncommon cause of neonatal jaundice. Antenatal Magnetic Resonance Imaging (MRI) diagnosis of EHBA has not been published to the best of our knowledge till date. EHBA with cystic component is likely to be mistaken for choledochal cyst. A case that was antenatally predicted and postnatally confirmed by surgery and histopathology is being reported. All imaging signs are analyzed herewith. Imaging helps in the prediction of EHBA and also helps in early postnatal surgical referral which in turn improves the results of Kasai's portoenterostomy.

Basal cell carcinoma - diagnosis

Basal cell carcinoma is the most common skin cancer in the Caucasian population. The cancer arises in sun exposed areas of the skin. The incidence of morbidity is high and it is still growing. The metastatic rate is low, but the enlarging tumor may cause severe tissue disfigurement and a poor cosmetic outcome. The diagnosis is usually clinical but there are many subtypes of this carcinoma and correct diagnosis is the clue to appropriate treatment of the lesion. The main problem in basal cell carcinoma management is the high recurrence rate.

Liver specific magnetic resonance imaging contrast medium for evaluation of focal liver lesions - Initial experience at a service hospital

BACKGROUND

Contrast enhanced MRI is today considered the investigation modality of choice in detection and characterization of focal liver lesions. The conventional MRI contrast media like Gadolinium (Gd) chelates undergo elimination through the urinary pathway and are not selectively concentrated or metabolized in the liver. Gadobenate dimeglumine (Chemical name: Gadolinium-BOPTA) is a promising newer liver specific MRI contrast medium having additional properties of selective uptake and biliary excretion by hepatocytes. Our study was designed as a pilot study to evaluate the utility of Gd-BOPTA in detection and characterization of focal liver lesions.

METHODS

Fifty-three consecutive patients with focal liver lesions (excluding only simple hepatic cysts) detected on ultrasonography and CT abdomen, were prospectively subjected to standardized MRI protocol for the liver, using Gd-BOPTA as the intravenous contrast medium. An additional T1W axial scan of the liver was incorporated in the study protocol, at a delay of 2 h post-contrast, in all patients.

RESULTS

In the study population, the combination of USG and contrast enhanced CT abdomen findings were adequate to reach a definitive diagnosis in 70% of the patients. The liver specificity of Gd-BOPTA contributed to improved lesional characterization in 9/50 patients (18%) on the delayed phase images.

CONCLUSION

The study revealed that the liver specific properties of Gd-BOPTA can be used to obtain additional information to improve characterization of focal hepatic lesions, when delayed phase scans are included in the study protocol.

Unusual sites of epidermoid cyst

Epidermoid cyst is usually due to infection of pilosebaceous gland or due to traumatic migration of epidermis to the deeper structure of skin. They may present in any place of body which is lined by squamous epithelium. They are rarely present in head neck and in oral cavity. We are presenting rare cases of epidermoid cyst presenting in post aural region and floor of mouth.

Persistent mullerian duct syndrome

Persistent Mullerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism in which Mullerian duct derivatives are seen in a male patient. This syndrome is characterized by the persistence of Mullerian duct derivatives (i.e. uterus, cervix, fallopian tubes and upper two thirds of vagina) in a phenotypically and karyotypically male patient. In this article we present the USG and MRI features of a case of PMDS with bilateral cryptorchidism and left sided inguinal hernia, containing the uterus and fallopian tubes.

Lymphatic malformation in adult patient: a rare case

Lymphatic malformation is an uncommon anomaly that commonly occurs in the posterior triangles of infants. The case presented here was an adult male patient with swelling in submental region. This site often leads to misdiagnosis of other common pathology including plunging ranula or lipoma. However, USG and MRI were done for diagnosis of the lesion by which final diagnosis of lymphatic malformation was made. Surgical excision was carried out and histopathology confirmed the primary diagnosis. No recurrence is seen in one and half year follow-up period.

An unusual complication of CSOM - Lateral sinus thrombosis with lung abscess: A clinicoradiological study

AIMS

To present a case report of a child presenting with lateral sinus thrombosis with bilateral multiple lung abscesses as a rare consequence of CSOM with an emphasis on the radiological findings.

MATERIAL AND METHODS

An 11-year-old male child with a history of pyrexia of unknown origin, right-sided torticollis, cough with expectoration and right ear discharge was referred to us from department of paediatric medicine. Chest examination revealed dull areas on percussion and areas with bronchial breath sounds on auscultation bilaterally. Otological examination revealed right attic retraction pocket filled with cholesteatoma, post-auricular tenderness and Greisinger's sign along with foul smelling muco-purulent discharge.

RESULTS

Routine blood investigations revealed normocytic normochromic anaemia, polymorpho-nuclear leucocytosis and raised ESR. Audiological investigations showed a right-sided mixed hearing loss. Digital radiography of chest showed multiple thin walled cavities involving all of the lung zones bilaterally. USG (Ultrasonography) of neck showed thrombosis of right internal jugular vein. CT scanning of head, neck and thorax showed soft tissue collection within the right mastoid with erosion of posterior wall & presence of gas bubble in the right sigmoid sinus and thrombosis of right internal jugular vein and multiple abscess cavities occupying both lung parenchyma. The patient was initially managed with conservative antibiotic therapy for lung abscess followed by radical mastoidectomy and thromboembolectomy from the lateral sinus.

CONCLUSION

Otogenic lung abscess though rare in this present postantibiotic era, it can occur in underprivileged and poor population like our country.